Thursday, April 30, 2015

I subscribe to the NYT so I can go from a Feed rendered in Reeder 2.0 on my i6 to the articles rendered in mobile WedKit. I’ve gotten used to hitting an interstitial ad on initial page view, a quick back and forth clears that. (Don’t try to hit the close button, doesn’t work.) I’ve even gotten used to hitting the ‘continue’ button they’ve embedded to make things even more painful.

Today, however, articles are so infested with interlaced ads, and so slow to render, that I’m getting to the end of the road. I sent a message via the NYT subscriber web contact form:

It is increasingly hard to read the NYT on a mobile device. My iPhone is very slow to display pages, it may be related to changes made to embed more advertising.

The articles are also now broken up by ads and harder to read.

I'm really losing patience. The next step is to give up my subscription, maybe try The Economist instead.

… 45 years or older, overweight or obesity, or a first-degree relative with diabetes. Women with a history of gestational diabetes or polycystic ovarian syndrome … African Americans, American Indians/Alaska Natives, Asian Americans, Hispanics/Latinos, and Native Hawaiians/Pacific Islanders …

I should be under 100, typically under 90, so that’s not a good number. It’s in the “pre-diabetes” range, and the current enthusiasm is to start treatment with meds in the hope of delaying the onset of “true” diabetes. Of course there’s also the theoretical benefit of weight loss and exercise, but few people manage that. Unfortunately we know weight loss programs rarely work, and the reports of med efficacy smell dubious to me, so it’s not entirely clear how useful the “pre-diabetes” diagnosis really is. The diagnosis, of course, is likely to raise one’s health insurance costs, though ObamaCare helps somewhat.

Since I’m already a skinny fitness nut my family doc wanted to completely ignore this, presumably on the grounds that there’s nothing useful to do about it. A wise recommendation, but I’m not built that way.

Poking around the net I found a BMJ article on a statistical model that tries to put some personalized precision medicine context around that fasting glucose. The researchers settled on 7 factors [1] that seemed to predict 3 year conversion to diabetes (yeah, only 3 year range). So I ran the Diabetes risk prediction tool on myself.

I got 91 points; the instrument recommends consideration of preventive steps for scores of 146 and up. Which vindicates my FP’s intuition (maybe she does the instrument in her head?).

Figuring out what 91 points means for 3 year conversion to Diabetes is a lot harder. I didn’t find anything that mapped scores onto risk quartiles! The data on 3 y progression ti diabetes per quartile was, very roughly:

1st quarter: 10%

2nd quartile: 20%

3rd quartile: 30%

4th quartile: 60%

I’m guessing my odds are probably in the 25-30% range over 3 years. So pretty high over 10 years, but the bottom line is that there’s really not enough data to justify taking an (invariably) icky medicine.

So I’ll just keep playing with my glucometer [2]…

[1] The HbA1c (glycosylated Hb) value is weird in this study. Normal HbA1c is usually given as 4.0-5.9%, but in this study anything above 4 starts to pile on bad points. This could be either a sign that there’s something funky with their model, or a sign that we should redefine the normal range for HbA1c (I’m 5.2, “normal”, but on their chart it lines up with a fasting glucose of about 105).

Lastly, the paper text says “baseline fasting glucose was by far the most important predictor” which does make me wonder if the other 6 factors mean anything.

[2] Since I’m kind of curious about what’s going on I bought a glucometer on Amazon (I paid $28 or so, it’s $11 today. They make their money on the proprietary strips.) My 1-2h post-prandial glucose is identical to my fasting glucose — 103. “Normal” is less than 140. So that’s weird. Next time i’ll redo the standard sample test — maybe the glucometer is dead. Or maybe the FBG/PPG ratio is an interesting predictor …

[3] I do idly wonder about getting a TSH (thyroid stimulating hormone).

Saturday, April 04, 2015

Rather than a free-standing slate/tablet computer, the Zenith CruisePAD was a remote terminal to one's PC. It was designed to allow the user to interact with that PC's applications from a distance over a wireless network. What made it interesting to me was that it let one do so directly on the CruisePAD's screen, using either a stylus or finger.

This was an interesting approach given when it was released. In that year, 1995, neither Wi-Fi (which came into existence in 1999 with the formation of the Wi-Fi Alliance), nor the IEEE 802.11 protocols on which it was based, were available (the original version of the IEEE 802.11 standard was not released until 1997). Hence, it relied upon a proprietary 2.4 Ghz spread-spectrum radio protocol which they called CruiseLAN…

We played with tech like this at a 1990s Electronic Health Record/transaction processing startup called Abaton.com (no trace of it on the web btw, domain taken long ago). Ultimately impractical, but very cool. This was the era of the PalmPilot device, and we (ok, I) imagined walking up to a wall display and automatically switching from the itty-bitty Palm display to something real big.

That’s what I want for my iPhone. I don’t want the cost and hassle of another OS with all of the overhead of apps and licensing and bugs and DRM restrictions and updates and hacks. I just want a frigging wireless dumb display that can be shared between multiple devices. It would be nice to play video on it, but really I want to read. I’d be delighted if it used Digital Ink and cost $100 with a 1 week battery life.

That’s what I want. Google is much more likely to do this on Android than Apple on iOS; it’s the one thing that might tempt me to the Dark Side.

I wonder if Apple’s App Store rules prevent a 3rd party (Amazon?) from producing a reading app that would communicate with a Digital Ink display via Bluetooth….